Players who have had ACL surgery, whats the prognosis?

Sam

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With a lot of talk (and concern) about the long term effects of Falcao's ACL injury, and subsequent surgery, I thought it'd be interesting to find out a bit more about this kind of injury, and whether or not its as severe and career changing as it appears to be, or is made out to be.

Now admittedly, when it comes to the severity of injuries I have a very limited knowledge of what to expect and how players come back from them. So is there any example of players who have recovered 100% from ACL injuries? Off the top of my head I think RVP had this injury the year before he joined us and recovered perfectly. On the opposite side, is there any examples of players that have never properly recovered from this kind of injury? And for people who have better knowledge of the science behind injuries such as this, what is the general outlook for players who suffer this injury?
 
Obviously things have moved on a bit from the 1980s and 1990s when the likes of Paul Gascoigne, Ian Durrant and Michael Mols suffered it and were never the same again. Then again I'm not sure Michael Essien was quite the same presence after his ACL tear. Marc Overmars, Alan Shearer, Roy Keane and Ruud Van Nistelrooy did well after their injuries. The success rate nowadays of getting back to top gear is probably somewhere in the region of 40-70%.
 
Sam said:
With a lot of talk (and concern) about the long term effects of Falcao's ACL injury, and subsequent surgery, I thought it'd be interesting to find out a bit more about this kind of injury, and whether or not its as severe and career changing as it appears to be, or is made out to be.

Now admittedly, when it comes to the severity of injuries I have a very limited knowledge of what to expect and how players come back from them. So is there any example of players who have recovered 100% from ACL injuries? Off the top of my head I think RVP had this injury the year before he joined us and recovered perfectly. On the opposite side, is there any examples of players that have never properly recovered from this kind of injury? And for people who have better knowledge of the science behind injuries such as this, what is the general outlook for players who suffer this injury?
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I wrecked my ACL back in 1984, it ended my playing career which had only just started. Back then they really didn't know how to fix them and they took some muscle lining and wrapped it around my knee to try and provide stability. I spent 6 weeks with a full length cast on my leg which had a bend at the knee. Within 30 seconds of the doctor removing the cast we knew it hadn't done a thing.
I spent the next 22 years living with a knee that would either lock up or collapse if I wasn't careful. The locking up came about because of a "bucket handle" tear in my cartilage.
In 2006 due to my involvement with the NZ national side from photography and video work I got to know th physio who put me on to a new up and coming surgeon. I went and saw this surgeon who told me he could fix my knee so a month or so later he operated.

He took part of my right hamstring and used that to replace the long gone ACL. It worked brilliantly and I haven't had any issues since. The biggest problem is that i no longer have any cartilage in the knee so every now and then the knee flares up and it becomes painful to walk however if I am careful this doesn't happen much.

The big secret now to ACL injuries is the rehab. If you do what they tell you to do and work very hard a complete recovery is possible. Building up the muscles around the knee and the hamstring as well after an ACL will mean a full recovery.

As long as Falcao's cartilage is ok then he should be able to play for a decent time and should be as good as he was before the break. If he has a damaged cartilage he will have to manage things more and work harder with strengthening work.
 
Gio said:
Obviously things have moved on a bit from the 1980s and 1990s when the likes of Paul Gascoigne, Ian Durrant and Michael Mols suffered it and were never the same again. Then again I'm not sure Michael Essien was quite the same presence after his ACL tear. Marc Overmars, Alan Shearer, Roy Keane and Ruud Van Nistelrooy did well after their injuries. The success rate nowadays of getting back to top gear is probably somewhere in the region of 40-70%.
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IIRC, Xavi tore his ACL too in 2005 and he still managed to reach his prime.
 
Stack said:
I wrecked my ACL back in 1984, it ended my playing career which had only just started. Back then they really didn't know how to fix them and they took some muscle lining and wrapped it around my knee to try and provide stability. I spent 6 weeks with a full length cast on my leg which had a bend at the knee. Within 30 seconds of the doctor removing the cast we knew it hadn't done a thing.
I spent the next 22 years living with a knee that would either lock up or collapse if I wasn't careful. The locking up came about because of a "bucket handle" tear in my cartilage.
In 2006 due to my involvement with the NZ national side from photography and video work I got to know th physio who put me on to a new up and coming surgeon. I went and saw this surgeon who told me he could fix my knee so a month or so later he operated.

He took part of my right hamstring and used that to replace the long gone ACL. It worked brilliantly and I haven't had any issues since. The biggest problem is that i no longer have any cartilage in the knee so every now and then the knee flares up and it becomes painful to walk however if I am careful this doesn't happen much.

The big secret now to ACL injuries is the rehab. If you do what they tell you to do and work very hard a complete recovery is possible. Building up the muscles around the knee and the hamstring as well after an ACL will mean a full recovery.

As long as Falcao's cartilage is ok then he should be able to play for a decent time and should be as good as he was before the break. If he has a damaged cartilage he will have to manage things more and work harder with strengthening work.
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Sorry about your injury. That's a pretty interesting read though, I assume that Falcao was given the absolutely best treatment that money could buy so hopefully he'll be grand.
 
Gio said:
Obviously things have moved on a bit from the 1980s and 1990s when the likes of Paul Gascoigne, Ian Durrant and Michael Mols suffered it and were never the same again. Then again I'm not sure Michael Essien was quite the same presence after his ACL tear. Marc Overmars, Alan Shearer, Roy Keane and Ruud Van Nistelrooy did well after their injuries. The success rate nowadays of getting back to top gear is probably somewhere in the region of 40-70%.
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Surely it would be higher than that? I'm no expert but an ACL injury isn't as serious as it would have been 20-30 years ago.
 
Redo91 said:
Surely it would be higher than that? I'm no expert but an ACL injury isn't as serious as it would have been 20-30 years ago.
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I'm no expert either. While pretty much every player makes a full recovery in terms of getting back on the park, not every one gets back to their absolute peak level.
 
I seem to remember there being some sort of breakthrough with regards to ACL reconstruction in recent years. I think it was after Vidic's second spell out.
 
DesiBD said:
IIRC, Xavi tore his ACL too in 2005 and he still managed to reach his prime.
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Lahm tore his in 2005, too. Since then he is nearly injury free...

Matthäus tore his before he came back from Inter to Bayern in 1992... He played until 2001... At that time it still was often career ending.
 
Gio said:
Obviously things have moved on a bit from the 1980s and 1990s when the likes of Paul Gascoigne, Ian Durrant and Michael Mols suffered it and were never the same again. Then again I'm not sure Michael Essien was quite the same presence after his ACL tear. Marc Overmars, Alan Shearer, Roy Keane and Ruud Van Nistelrooy did well after their injuries. The success rate nowadays of getting back to top gear is probably somewhere in the region of 40-70%.
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Essien was one of the first names that jumped to my mind. He was a shadow of the player he once was after his injuries, I'm sure I read somewhere that he was never able to fully extend his leg after his surgeries (no idea if that was ACL related or not though)

Those stats do seem to be a little on the low side though. Surely the success rate would be a lot higher with the medical advances of today?

Stack said:
I wrecked my ACL back in 1984, it ended my playing career which had only just started. Back then they really didn't know how to fix them and they took some muscle lining and wrapped it around my knee to try and provide stability. I spent 6 weeks with a full length cast on my leg which had a bend at the knee. Within 30 seconds of the doctor removing the cast we knew it hadn't done a thing.
I spent the next 22 years living with a knee that would either lock up or collapse if I wasn't careful. The locking up came about because of a "bucket handle" tear in my cartilage.
In 2006 due to my involvement with the NZ national side from photography and video work I got to know th physio who put me on to a new up and coming surgeon. I went and saw this surgeon who told me he could fix my knee so a month or so later he operated.

He took part of my right hamstring and used that to replace the long gone ACL. It worked brilliantly and I haven't had any issues since. The biggest problem is that i no longer have any cartilage in the knee so every now and then the knee flares up and it becomes painful to walk however if I am careful this doesn't happen much.

The big secret now to ACL injuries is the rehab. If you do what they tell you to do and work very hard a complete recovery is possible. Building up the muscles around the knee and the hamstring as well after an ACL will mean a full recovery.

As long as Falcao's cartilage is ok then he should be able to play for a decent time and should be as good as he was before the break. If he has a damaged cartilage he will have to manage things more and work harder with strengthening work.
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Thanks for the detailed post mate, really appreciate the info. I'm sorry to hear about your injury though, good to know things are looking a lot better now.

I thought the point you made about the rehab was really interesting. From what we've heard, Falcao supposedly took his rehab very seriously and followed the surgeons recommendations to the letter, and didn't rush back to make the World Cup. Hopefully that means his recovery will be as good as possible. It makes you wonder if we dodged a bullet with Vidal mind, considering his rushed rehab and determination to play in the World Cup.
 
Blackwidow said:
Lahm tore his in 2005, too. Since then he is nearly injury free...

Matthäus tore his before he came back from Inter to Bayern in 1992... He played until 2001... At that time it still was often career ending.
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I never knew Lahm had done his. Certainly didn't effect him or have any effect on his pace or mobility.

He would of been quite young if it was in 2005, I wonder if age has any impact on how good/bad a recovery you make?
 
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I can understand the ACL injury for an older player like Falcao because it would take so long to get back into the swing of things it could remove the best days of your football career and replace it with surgery but I suppose you have to see the effects first hand to understand it. I myself am out for over a month with an injury and 2 weeks into physio for a knee injury and the difference in performance more so out of fear of doing more damage is much greater than the actual effects, everything from extra pressure to mobility is effected both physically and mentally.
 
Sam said:
I never knew Lahm had done his. Certainly didn't effect him or have any effect on his pace or mobility.

He would of been quite young if it was in 2005, I wonder if age has any impact on how good/bad a recovery you make?
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Matthäus had his ACL injury on 12th of April 1992 (with 31... we do not only talk about young players) - that is why Bayern got him back so cheap. He made his comeback in a Bundesliga match only five months later on September 19th.

He played until 39...

That were still the times when an ACL was often thought to be career ending.
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The problem with the ACL injuries today is often the comeback. If you watch people that had an ACL in the recent year and came back often muscle injuries followed as the players somehow were out for a too long time.

Badstuber - at him it were even 2 ACLs and more than a year off - started team training in April. He was already back in great shape but it could be that he was rushed into too many matches because of injury problems and form problems of others. Now he is out with a muscle rupture. Could be that they use their muscles now differently to get pressure of their knee...
 
Giovanni van Bronckhorst had this injury in 2002. Went on to play for the 2006 Barca side that won the Champions League, and he played a brilliant World Cup in 2010 aged 37. Shearer, Ruud and Xavi have been mentioned.

Quite interesting that I can't really recall that many players who never recovered, and most of them were already at the end of their career. But I just read what @Blackwidow said about the problems, and I remember Afellay picking up injury after injury after his recovery from the ACL tear, first time in two years he is really getting fit, so I guess it isn't a smooth recovery for everyone.

Back when Ruud van Nistelrooij got the injury there already seemed to be some great specialists for treatment (think Dr. Steadman was the one operating) and I vaguely remember some documentary showing how they used a tendon from the hamstring or knee to repair the damage. They stated that the knee actually would or could become stronger than before the injury.

Isn't ACL-injury also one of the most common injuries in American Football? Don't know how well those players recover.
 
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Henrik Larsson said:
Back when Ruud van Nistelrooij got the injury there already seemed to be some great specialists for treatment (think Dr. Steadman was the one operating) and I vaguely remember some documentary showing how they used a tendon from the hamstring or knee to repair the damage. They stated that the knee actually would or could become stronger than before the injury.
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I think Steadman (or his colleagues) is still the guy everybody goes to. The Bayern players always were sent there and recently Badstuber and Martinez were in Vail, too.
 
They're starting to use synthetic as well now to repair acl's. Nick Malceski from sydney swans (afl pretty much the most physically demanding ball sport) has had it done twice and is still one of the best players in the league.

It's called lars surgery
 
I tore my ACL back in 2004. I never actually had surgery to repair it due to needing a minimum 6 weeks off work to aid recovery. So after 7 years of playing in goal, crumbling to a heap whilst pushing a shopping trolley in ASDA and being extremely limited in certain sexual positions - i decided to take the plunge and have my knee operated on.

When i was initially offered the surgery in 2004 - i was informed that the middle third of my patella would be used to form the new ligament, with a severe amount of pain during recovery. However when i went for surgery 7 years after they acutally harvested my hamstring to form thee new ligament.

I had no pain at all and within a year was playing full contact football again.

3 years on and i am now playing in midfield and have not had 1 problem with me knee since - the only problem i have now is that i am not 20 anymore.

It seems that since the hamstring grafts have become more and more common, players have been recovering from the injury a lot quicker.

What used to be a 9-12 month lay off is now 6 - 9 month.
 
If it's just a straight ACL tear these days there should be a full recovery. As someone said it's the rehab which is the most important part. Back in the 1980s they used to bring back players far too quickly post surgery and they hadn't built up enough strength in the leg and would often tear it again.

The rehab usually takes a minimum of six months and depends on how quickly the player can get strength back in the knee. I read that aside from a lot of running and barbell squats/ lunges etc they also get players to bounce on trampolines (???) to build up muscle stability in the leg. Ahh modern sports science...

And as someone said as well it's cartilage or lack there of which can end a players career. It's what happened primarily with Owen Hargreaves. They'd taken most of his cartilage out in both his knees. It doesn't grow back so it just leads to bone rubbing on bone and the knee joint slowly degenerates as a result. Falcao should make a complete recovery.
 
Yeah Essien is definitely a top shout when it comes to ACL injuries wrecking careers. Lucas is another who's nowhere near the same level pre-injury.

Hard to think of any others though.
 
Sergio Canales damaged his ACL, recovered and damaged it again almost immediately. He's doing better this time and is playing regularly now. Difficult to say if he's lost anything, he's still only 23.

Khedira was out for 6 months last season with an ACL. Recovered just in time to play in the CL final and do well with Germany in the WC. However he got injured before the WC final and has hardly played since - may be back in action (training) after the international break.

Varane had what's normally less serious knee surgery (a meniscus repair) but kept picking up knee injuries for months afterwards. He only started to look fit again towards the end of last season - nearly a year after the surgery.
 
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It's probably a mental thing as much as anything. I only sprained my MCL last year and I still don't feel right about it and that's more of a stabilising ligament rather than the ACL.

You get muscle imbalances with so long out of action and you sometimes see players over compensate and the other knee blows soon after
 
Derrick Rose (former NBA MVP) hasn't been the same player since he tore his ACL a couple of years ago, but that's another sport and maybe more stressful for your knees... I'd say it depends from case to case, you'll find numerous examples of players who never fully recovered, but on the other side you'll have players who came back stronger after their surgery.
 
When I tore my patella tendon, had surgery and did physio for 6 months, I was a nervous wreck the 1st time back on the pitch. Didn't want to get stuck into tackles etc , took me about 6 months before I was ready to go all out on that knee.

I'd say getting back to your best is as much confidence in your knee as it is about rehab.
 
jojojo said:
Khedira was out for 6 months last season with an ACL. Recovered just in time to play in the CL final and do well with Germany in the WC. However he got injured before the WC final and has hardly played since - may be back in action (training) after the international break.
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Khedira had muscle problems (not an "injury") before the World Cup final and that is why he missed. They did not risk to bring somebody in that had problems. He had a muscle rupture now in September during a Real match what takes him out of the match now again for some weeks.

Khedira is a special story as his career was already in danger 2005/06 at the beginning because of his knees...

There is a lot players who have had ACLs during the last 2 years in Germany - and knee injuries - it is said that it is due to changed movement as with more pressing you have more "turns" to the knee and more stress to it.
 
Bebe injured his ACL as soon as he first went on loan, spent a whole season at Besiktas doing nothing. His next loan was a huge success and he was one of the best players at his club. Doesn't seem to have lost any of his pace or power
 
I've had three knee operations since last March. Two were ACL reconstructions: the first used a hamstring graft, the second a piece of the patellar tendon. The other was meniscal repair, which oddly was way worse than the other two. Anyway. I got unlucky reinjuring myself, but ACL reconstructions are routine nowadays. Someone like Falcao, who trains seven days a week and has access to some of the best doctors, physios, and psychologists in sport, should be absolutely fine. Everything he does will be very closely monitored. Adrian Peterson is a great example of how an athlete who's preternaturally motivated can recover from knee injury.
 
Giuseppe Rossi is another one who's career has been wrecked by ACL injuries. A shame, because at one point he was one of the most lethal finishers in Europe.

But like others have said, it is very treatable and many have gone on to make complete recoveries.
 
Archie Leach said:
It can take away a bit of your pace, no? Which would affect someone like Walcott more than say, Falcao.
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No reason it should really. The ham-string allograft seems to be the operation of choice and it's theoretically possible that a weakened hamstring might slow you down. However, proper rehab can get the affected hammy exactly as strong as the one on the non-operated leg. I managed it and I had my ACL reconstruction aged 40!
 
Dominick Cruz, a UFC fighter who was the reigning UFC Bantamweight champion and looked untouchable, tore his ACL back in early 2012. He had to have two surgeries after his body rejected the first one. He also tore his groin before he could return. Although it's too early to unequivocally say he's the Dominick Cruz who dominated pre-injury, he looked nimble in his return fight against Mizugaki after more than two years out.

I don't think there's as much to the injury as we imagine. As initially horrible and debilitating as it is, there are enough examples to suggest that it doesn't automatically mean a player loses their edge. There's also no way of knowing the circumstances surrounding players who've had the injury and never quite returned to their best. There are so many other factors that could affect them.

I've had some ligament damage to my knees during my time as a runner, most notably in 2011. I stepped out of my house for a run one night and my leg just collapsed and stopped me instantly. I tried to run it off, not realising that it was an injury that would stop me running properly for a good 4 months. I think that silly insistence on persisting made it worse. I never sought medical advice and had a pronounced limp for a while, but it seems to be okay now. Not sure how effective it is towards preventing those injuries (I'm guessing quite significant), but I like to think it's taught me the value of a good warm-up.
 
If we're talking UFC, Ireland's own Conor McGregor is a great example of someone apparently unaffected by an ACL repair. He progressed through his rehab ridiculously quickly too. I had my op around the same time and was still trying to get my knee to full extension when he was jumping round the gym doing lunges. The healing power of youth :(
 
Interestingly, Rogan mentioned during Cruz' comeback fight that he suspected Cruz had been training when he should have been resting after his first ACL surgery, which is why he eventually needed a second. I'm not sure how much truth there is to that.

I think the psychology of behind injuries is also something interesting and worth considering. Like Pogue mentioned, McGregor's jumping around and determined to get fully fit, and then there was talk that Hargreaves, who no doubt had his share of bad injuries, was always feeling delicate.
 
Fener1907 said:
Interestingly, Rogan mentioned during Cruz' comeback fight that he suspected Cruz had been training when he should have been resting after his first ACL surgery, which is why he eventually needed a second. I'm not sure how much truth there is to that.

I think the psychology of behind injuries is also something interesting and worth considering. Like Pogue mentioned, McGregor's jumping around and determined to get fully fit, and then there was talk that Hargreaves, who no doubt had his share of bad injuries, was always feeling delicate.
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Definitely.

I was surprised how much physical bravery is a part of rehab. The ability to push through pain. Only ever had one long term rehab and completely changed my opinion about what life is like for footballers working to get fit after a serious injury. Always imagined splashing about in a pool, combined with lots of massages. Never realised you had to endure so much discomfort.
 
The big thing with the rehab for me was getting a full range of movement from the knee. This meant painful stretching of the knee twice a day as well as the muscle strengthening. At my age it was also a little harder to do and then add in work getting in the way. I am pretty sure that full time pro athletes can get back to full fitness with no loss of strength or speed with the recent improvements in ACL operations.
 
Irrational. said:
Giuseppe Rossi is another one who's career has been wrecked by ACL injuries. A shame, because at one point he was one of the most lethal finishers in Europe.

But like others have said, it is very treatable and many have gone on to make complete recoveries.
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To be fair Rossi has had a number of ACL injuries. I think I am right in saying this is only Falcao's second ACL injury. Also Falcao's latest injury was as a result of a really poor challenge. It could have happened to anyone. I remember seeing footage of Rossi picking up one of his ACL injuries and it was a really innocuous challenge. I think this is of some relevance for Falcao in the long run. Provided he isn't on the receiving end of any more awful challenges he should be fine. Unfortunately for Rossi it seems an ACL injury is guaranteed to happen every year or so no matter what.
 
Stack said:
The big thing with the rehab for me was getting a full range of movement from the knee. This meant painful stretching of the knee twice a day as well as the muscle strengthening. At my age it was also a little harder to do and then add in work getting in the way. I am pretty sure that full time pro athletes can get back to full fitness with no loss of strength or speed with the recent improvements in ACL operations.
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What if you are rather negligent and don't follow up with your rehab with the required intensity. Does that mean you can't exercise later on and make it better or is there some sort of a definitive setting period after the operation?
 
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